Most Relevant Information
Provider Data
| NPI Number: | 1003278730 |
| Provider Name: | TYLER T BIRCH D.O. |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/22/2016 |
| Last Updated: | 04/09/2020 |
Provider Practice Location
520 S EAGLE RD STE 3102
MERIDIAN
ID
836426352
Practice Location Phone/Fax
| Phone: | 2087065100 |
| Fax: |
Provider Mailing Location
500 W FORT ST # 111R
BOISE
ID
837024501
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |